RESEARCH SUPPORT, N.I.H., EXTRAMURAL
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The course of substance use disorders in patients with borderline personality disorder and Axis II comparison subjects: a 10-year follow-up study.

Addiction 2011 Februrary
AIM: The purpose of this study is to detail the course of substance use disorders (SUDs) over 10 years of prospective follow-up among patients with borderline personality disorder (BPD) and Axis II comparison subjects.

DESIGN: This study uses data from the McLean Study of Adult Development (MSAD), a multi-faceted study of the longitudinal course of BPD using reliable repeated measures administered every 2 years over a decade of prospective follow-up.

SETTING: All subjects were initially in-patients at McLean Hospital in Belmont Massachusetts. PARTICIPANTS; A total of 290 patients with BPD and 72 Axis II comparison subjects were assessed at baseline and five waves of follow-up.

MEASUREMENTS: The Structured Clinical Interview for DSM-III-R Axis I Disorders (SCID-I), the Revised Diagnostic Interview for Borderlines (DIB-R) and the Diagnostic Interview for DSM-III-R Personality Disorders (DIPD-R) were administered six times. Generalized estimating equations were used to assess longitudinal prevalence of SUDs. Kaplan-Meier analyses were used to assess time-to-remission, recurrence and new onsets of SUDs.

RESULTS: The prevalence of SUDs among borderline patients and Axis II comparison subjects declined significantly over time, while remaining significantly more common among those with BPD. More than 90% of borderline patients meeting criteria for a SUD at baseline experienced a remission by 10-year follow-up. Recurrences and new onsets of SUDs were less common (35-40% and 21-23%).

CONCLUSIONS: Remissions of alcohol and drug abuse/dependence among borderline patients are both common and relatively stable. Results also suggest that new onsets of these disorders are less common than might be expected.

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